Fat embolism syndrome after minor trauma in an adolescent with Duchenne muscular dystrophy: a case report

Fat embolism syndrome (FES) is rare in children and not routinely considered as a differential diagnosis even in patients with established risk factors.We report a 17-year-old male with Duchenne muscular dystrophy who presented with severe hypoxemia, shock, and altered mental status 4 hours after a minor fall from a wheelchair.Initial evaluation, including chest computed tomography, lowerextremity radiography, and echocardiography, suggested aspiration pneumonia without evidence of pulmonary thromboembolism, fracture, or cardiomyopathy.Despite mechanical ventilation and vasopressor support, respiratory failure and shock progressed.Repeat physical examination identified petechial lesions.Fundoscopy revealed Purtscher flecken while brain magnetic resonance imaging showed a starfield pattern of restricted diffusion.The formal radiology report read diffuse alveolar hemorrhage compatible with FES on the initial computed tomography and a subtle fracture of the right distal femur on the radiography.Follow-up echocardiography showed pulmonary hypertension.Collectively, the final diagnosis was established as FES.This case illustrates that lowenergy trauma in Duchenne muscular dystrophy can cause occult fracture and FES, requiring targeted reassessment when clinical deterioration is disproportionate to the initial diagnostic impression.